HomeMy WebLinkAbout0028 CANDLEWICK LANE �g C�� �� ��--�i
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map �Iz (o Parcel-, d LO Application # a2d 106, a
Health Division -Date Issued
Conservation Division , . Application Fee
Planning Dept. a Permit Fee S
Date Definitive Plan Approved b Planning Board
pp Y g . .. • '- �� .
Historic - OKH — Preservation/ Hyannis
Project Street Address c (a- C1<e c,y9CAC_ RC,
Village �1s
Owner Kam= �� v Address o2 CC._J(eW� 1K tZc(
Telephone ? (P ^ KY7(0
Permit Request
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay _
Project Valuation 1 ` 1 Construction Type
Lot Size a ce, Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family ff-' Two Family ❑ Multi-Family (# units)
Age of Existing Structure 19 T� Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ®(Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area (sq.ft.) �� Basement Unfinished Area (sq.ft) 1612
Number of Baths: Full: existing_ new Half: existing new
Number of Bedrooms: 3 existing j2>/new
4
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: S-Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes �.No Fireplaces: Existing New Existing wooc26al stove'~I- Y8'� ❑ No
Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn O existing ❑4pew<size_
. CD
Attached garage: Otexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other. IN) F
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ?.No. If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
_ (BUILDER OR HOMEOWNER)
Name4 S�, `' � �v Telephone Number 7 1-7
Address 2-t L P�L (-- License#_
Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE ' DATE 1
r
FOR OFFICIAL USE ONLY
,G :# APPLICATION#
r DATE ISSUED e
MAP/PARCEL NO.
s
a
3
ADDRESS VILLAGE
OWNER
S44Y
x / •
Tt
t
DATE OF INSPECTION:
FOUNDATION\ 1
FRAME
INSULATION , .;
s FIREPLACE
ELECTRICAL: ROUGH FINAL
c
PLUMBING: ROUGH FINAL
GAS: =- ROUGH , - FINAL
f
:FINAL BUILDING
t
i
DATE CLOSED OU,T }x
ASSOCIATION PLAN NO.
. The Commomvealth of Massachusetts
Department of l"ndastrial AcciderZfs
QJ97ce ofLnvesfigations
600 Washington Street
Boston,MA 02II1
www.Inass guv1dia
Workers' Compensation Insurance-Affidavit; Bidlders/Contractors/IIectricians/Pitunbers
APnficant Information .
Please Print Legibly
Name (spsiness/orgaiafionadivi&.D:
Address:
. c CC C.
City/staff z/ : L-0,,4edl Phone#:
Are you an employer?Check the appropriate bow
I.❑ I am a employer with. 4: ❑I am a general coIItrictor and I �'e of project(regrdre
�.
employees(fnIl and/or part-tie).* have hired the sub-conractors 6; ❑Ne consirucfion
2.❑ I am a sole proprietor or parb2m- listed on the attached sheet; 7. odeliag
ship and have no employees These sub-contractors have g ❑Demolition
working for me.m any capacity. employees and have workers'
[No.workers'coin.ffis r npp comp,ma'mance.$ 9. ❑Building addition
] 5. ❑ We are a corporation and its I0.❑Electrical repairm or additions
3. I am a homeowner doing aTI work officers have exercised their
elir 11.0 PI,
repairs or additions
rays [No workers comp. light of exemption per MGL
insvzance regiiir i2ed.]t c.152, §1(4),and we have no ❑Roof r ePairs
employees.[No workers' : 13•❑Other .
comp,namrame required.]
*A-f applicant tbat checks box#I mast also M out the section bolow showing.their work=,compensation policy information
t Homeowners who submit thus affidavit infieating they are doing aU work and then hire outside co cusaf urs must submit n new affidavit indi
that check Phis box mast attached an addi5oaal sheet showing rho name of the ° snch
employees_ If fe sab-contractors have employees,they mast �aatIWtors and state whether or not$wsc entities have
Prrn ide then wnrkas a up.policy member.
I am an employer that is providing workers'campensadon insurance for my em
infarmadon. ployees Below is the po&cy arzd job site
hmmance Company Name:
Policy#or Self--ins.I ic.
Expiration Date:
Job site Address:
Attach a copy of the workers' compensation policy declarktion page(showing /e n
Fame to secure coy as Policy umber and expiration date).
erage rmpii ed under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1_,500.00 and/or one-year nngasoninmi; as well as civ>7 penalties in the form of a STOP WORK ORDER and a one
Of up to$250.00 a day against the violator. Be advised that a of this SttP,T„�,„+
�' ons of the DIA for' i;overage verification copy =y be forwarded to the Office of:
I do hereby cer&yy ander the pins and penakes qfpmjray tFiat the inforft=tbn provided above is true and correct
si aar�:
Phone# Z
6'91cial ase only. Do nut write in this are,to be completed by ctty or fawn offcciaL
City or Town:
PermitUcerse#
Issuing Authority(circle one):
L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5EI
6. Other
Contact Person: Phone#:
��5 rti Town of Barnstable
Regulatory Services
NAM• nwR�vcrwur�F, : Thomas F.Geiler,Director
Building Division
Tom Perry,Building Commissioner
200 Main Street,.Hyannis,MA 02601 -
www.town.b arnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:__�'y 1
JOB LOCATION:��{ C Dl c'� G\6�L
number street
n village
"HOMEOWNER":
name home phone_# . work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
DEFTNTTION OF HOMEOWNER
Persons)who owns a parcel of land on which he/she resides of intends to reside,on which there is,or is intended to
be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A
Person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be -
responsible for all such work performed under the building permit (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
m;r,imt,m inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
Signature of H meowner
Approval of Building Official {�
Note: Three-family dwellings containing 35,000.cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that "Any homeowner
,performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly'
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the pniicensed person as it would with a licen Supervisor. The homeowner acting as Supervisor is ultimately responsible. sed
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the Permit application,
ibilities of a Supervisor. On the last page of this
that the homeowner certify that he/she understands the respons issue is a fomi currently used by
several towns. YOU care t amend'and adopt such a fom>/cettification for use in your community.
Q:forms:homeexempt
i
Town of Barnstable
R�RNR Regulatory Services
t ' .
NA99. Thomas F.Geiler,Director
0.19.
o► ` Building Division
Tom Perry,Building Commissioner
200 Main Street;Hyannis,MA 02601
www.town.barnstable.ma.us
Office: .08-862-4038 F::.. ax:_.508-790,6230._: _.. .:..:. ...:._. _
Property Owner Must
omplete and Sign This Section
If Using A.Builder
as Own f the subject
/� l property
hereby authorize HZ4w. C� to act on ray behalf
in all matters relative to work authorize by this b permit
(Address Jo
**Pool fences and alarm are the responsi ' 'ty of the applicant. Pools
are not-to be filled befor fence is installed an ools are not to be
utilized until all final spections are performed ' d accepted.
1�J
Signature of Own Signature of Applicant
Vu
Print Name Print Name
Date
QYORMS:OWNERPERMISSIONPOOLS
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